Next-Generation Sequencing Based Approach to Identify Underlying Genetic Defects of Glanzmann Thrombasthenia

Glanzmann thrombasthenia (GT) is an autosomal recessive platelet function disorder characterized by mucocutaneous bleeding as the most common clinical phenotype. Patients with GT have normal platelet counts, platelet morphology but reduced platelet aggregation in response to various agonists. Homozygosity or compound heterozygosity for variants in the ITGA2B/ITGB3 genes is the genetic basis for GT. Establishing a molecular diagnosis is definitive and is important for predictive testing. Using multi-gene panels is an accurate, faster, and cost-effective mode as compared to Sanger sequencing in large genes. We used a targeted resequencing based approach to identify pathogenic variants in eight cases in seven families. These variants were validated using Sanger sequencing in patients as well as family members and were predicted probably pathogenic using in-silico prediction tools. The variants include three missense (3/7 = 43%) (ITGA2B:c.1028 T > C, ITGA2B:c.1186G > A, ITGB3:c.1388G > C), two deletions (ITGA2B:c.559delG, ITGA2B:c.3092delT), one duplication (ITGA2B:c.1424_1427dupAGGT) and nonsense variant (ITGA2B:c.2578C > T, p.Gln860Ter). Except for one case which was compound heterozygous, the rest of the cases were homozygous. We found two novel variants that are reported for the first time in GT. The targeted resequencing based approach revealed varied genetic variants in North Indian patients, including two novels ones. The high yield of our panel indicates its suitability for usage in larger cohorts for the genetic diagnosis of GT patients. This approach is cost-effective and less cumbersome as compared to Sanger sequencing for these large size genes with multiple exons. The information so obtained is helpful in prenatal testing, carrier analysis, and genetic counseling.     

Impact of ABCB1 Gene (C3435T/A2677G) Polymorphic Sequence Variations on the Outcome of Patients with Chronic Myeloid Leukemia and Acute Lymphoblastic Leukemia in Kashmiri Population: A Case–Control Study

Inherited polymorphic sequence variations in drug transport genes like ABCB1 impact a portion of patients with hematologic malignancies that show intrinsic or acquire resistance to treatment. Keeping in view inter-individual sensitivities for such drugs, we through this case–control study tested whether ABCB1 C3435T and G2677T polymorphisms have any influence on the risk and treatment response in patients with chronic myeloid leukemia (CML) and B-acute lymphoblastic leukemia (B-ALL). Genotyping for ABCB1 polymorphisms was performed by polymerase chain reaction-restriction fragment length polymorphism in 100 CML and 80 B-ALL patients along with 100 age and gender matched healthy controls. ABCB1 C3435T and G2677T polymorphism showed no association with CML. Genotype distribution revealed significant higher frequency of TT genotype for both SNPs in B-ALL cases and associated with increased B-ALL risk (OR 2.5, p = 0.04 for 3435TT; OR 2.4, p = 0.04 for 2677TT). There was no significant difference in genotype frequency of 3435C > T and 2677G > T among resistant and responsive groups for the two leukemia types. Kaplan–Meier survival plots revealed significantly lower event free survival in CML and B-ALL patients that were carriers of 3435TT genotype (p < 0.05). Multivariate analysis considered 3435TT genotype as independent risk factor for imatinib resistance in CML cases (HR 6.24, p = 0.002) and increased relapse risk in B-ALL patients (HR 4.51, p = 0.03). The current study provides preliminary evidence of a significant association between variant TT genotype and increased B-ALL risk. Also, results suggest that ABCB1 3435TT genotype increases imatinib resistance in CML and influence therapeutic outcome in B-ALL.     

Second Primary Malignancies in Chronic Myeloid Leukemia

Survival of patients with chronic myeloid leukemia (CML) has improved with the use of imatinib and other tyrosine kinase inhibitors. There is limited data on second primary malignancies (SPM) in CML. We analyzed the SPMs rates among CML patients reported to Surveillance, Epidemiology, and End Results (SEER) database during pre-(1992–2000) and post-(2002–2009) era. We used SEER Multiple Primary-Standardized Incidence Ratio session to calculate standardized incidence ratios (SIRs). Among 8,511 adult CML patients, 446 patients developed 473 SPMs. The SIR for SPMs in CML patients was significantly higher with observed/expected ratio:1.27, P < 0.05 and absolute excess risk of 32.09 per 10,000 person years compared to general population. The rate of SPMs for cancers of all sites in post-imatinib era were significantly higher compared to pre-imatinib era with observed/expected ratio of 1.48 versus 1.06, P = 0.03. This study showed that risk of SPMs is higher among CML patients. The risk of SPMs is significantly higher in post-imatinib era compared to pre-imatinib era.     

Changes in Complement Levels and Activity of Red Blood Cells,Fresh Frozen Plasma,and Platelet Concentrates During Storage

Complement cascade plays an important role in the field of transfusion medicine. The study aimed to detect the complement levels of different blood components and different blood types to explore the risk of transfusion of stored blood. The samples including red blood cells (n = 110), fresh frozen plasma (n = 120), and platelet concentrates (n = 104) from healthy blood donors in our center were collected. Complement components (C3, C4, C3b, C3d, and CH50) were assayed to evaluate the activation of complement. The complement levels of various blood components at different storage times were observed. The differences in complement levels of four blood types in various blood components were compared. The complement levels of red blood cells in storage were low, with no significant changes (P > 0.05). C3b and C3d levels in platelets began to significantly increase after storage for 3 days (P < 0.05). The fresh frozen plasma during storage had higher complement levels, and the concentrations of C3 and C4 decreased and C3b and C3d increased at month 4 (P < 0.05). The differences in complement levels of four blood types in various blood components did not significantly change (P > 0.05), but the C3b and C3d levels of AB fresh frozen plasma remained stable during storage, which different from other blood types. The transfusion of red blood cells was relatively safe in terms of complement activation. The activation of complement proteins occurred during the storage of platelet and plasma, except group AB plasma.Electronic supplementary materialThe online version of this article (10.1007/s12288-020-01338-0) contains supplementary material, which is available to authorized users.     

The Impact of Thromboelastography on Blood Transfusion Policy in Adult Cardiac Surgery—A Retrospective Observational Study from Eastern India

This study was conducted to determine the impact of thromboelastography (TEG) on blood transfusion policy regarding utilization and preparation of cryoprecipitate in adult cardiac surgery. The differences in total transfusion requirement, length of postoperative ICU stay and 24 h mortality were also studied after introduction of TEG in transfusion protocol. It was a retrospective, single-center, observational study conducted in adult patients underwent cardiac surgery from April 2008 to March 2016. Two thousand patients underwent surgery when TEG was used compared with 1000 control patients before availability of TEG. Significantly more patients in the TEG group versus the control group received cryoprecipitate (41 vs. 7%; p < 0.05), while fewer received a transfusion (60 vs. 87.5%; p < 0.05). Significant increase in cryoprecipitate preparation was observed after introduction of TEG. Patients underwent surgery in TEG group showed substantial reduction in administration of PRBC (2.1 vs. 3.5 U; p < 0.05); FFP (2.4 vs. 3.8 U; p < 0.05) and platelets (1.1 vs. 2.7 U; p < 0.05) compared to control group without compromising the length of ICU stay or postoperative mortality. A TEG-guided approach in adult patients undergoing cardiac surgery may increase the use of cryoprecipitate, while decreasing the overall requirement of blood transfusion.     

Satellite cells in human skeletal muscle; from birth to old age

Changes in satellite cell content play a key role in regulating skeletal muscle growth and atrophy. Yet, there is little information on changes in satellite cell content from birth to old age in humans. The present study defines muscle fiber type-specific satellite cell content in human skeletal muscle tissue over the entire lifespan. Muscle biopsies were collected in 165 subjects, from different muscles of children undergoing surgery (<18 years; n = 13) and from the vastus lateralis muscle of young adult (18–49 years; n = 50), older (50–69 years; n = 53), and senescent subjects (70–86 years; n = 49). In a subgroup of 51 aged subjects (71 ± 6 years), additional biopsies were collected after 12 weeks of supervised resistance-type exercise training. Immunohistochemistry was applied to assess skeletal muscle fiber type-specific composition, size, and satellite cell content. From birth to adulthood, muscle fiber size increased tremendously with no major changes in muscle fiber satellite cell content, and no differences between type I and II muscle fibers. In contrast to type I muscle fibers, type II muscle fiber size was substantially smaller with increasing age in adults (r = −0.56; P < 0.001). This was accompanied by an age-related reduction in type II muscle fiber satellite cell content (r = −0.57; P < 0.001). Twelve weeks of resistance-type exercise training significantly increased type II muscle fiber size and satellite cell content. We conclude that type II muscle fiber atrophy with aging is accompanied by a specific decline in type II muscle fiber satellite cell content. Resistance-type exercise training represents an effective strategy to increase satellite cell content and reverse type II muscle fiber atrophy.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-013-9583-2) contains supplementary material, which is available to authorized users.     

Longitudinal association between cognitive depressive symptoms and D‐dimer levels in patients following acute myocardial infarction

BackgroundA prothrombotic tendency could partially explain the poor prognosis of patients with coronary heart disease and depression. We hypothesized that cognitive depressive symptoms are positively associated with the coagulation activation marker D‐dimer throughout the first year after myocardial infarction (MI).MethodsPatients with acute MI (mean age 60 years, 85% men) were investigated at hospital admission (n = 190), 3 months (n = 154) and 12 months (n = 106). Random linear mixed regression models were used to evaluate the relation between cognitive depressive symptoms, assessed with the Beck depression inventory (BDI), and changes in plasma D‐dimer levels. Demographics, cardiac disease severity, medical comorbidity, depression history, medication, health behaviors, and stress hormones were considered for analyses.ResultsThe prevalence of clinical depressive symptoms (13‐item BDI score ≥ 6) was 13.2% at admission and stable across time. Both continuous (p < .05) and categorical (p < .010) cognitive depressive symptoms were related to higher D‐dimer levels over time, independent of covariates. Indicating clinical relevance, D‐dimer was 73 ng/ml higher in patients with a BDI score ≥ 6 versus those with a score < 6. There was a cognitive depressive symptom‐by‐cortisol interaction (p < .05) with a positive association between cognitive depressive symptoms and D‐dimer when cortisol levels were high (p < .010), but not when cortisol levels were low (p > .05). Fluctuations (up and down) of cognitive depressive symptoms and D‐dimer from one investigation to the next showed also significant associations (p < .05).ConclusionsCognitive depressive symptoms were independently associated with hypercoagulability in patients up to 1 year after MI. Hypothalamic–pituitary–adrenal axis could potentially modify this effect.     

Strength training-induced responses in older adults: attenuation of descending neural drive with age

Although reductions in resting H-reflex responses and maximal firing frequency suggest that reduced efferent drive may limit muscle strength in elderly, there are currently no reports of V-wave measurements in elderly, reflecting the magnitude of efferent output to the muscle during maximal contraction. Furthermore, it is uncertain whether potential age-related neural deficiencies can be restored by resistance training. We assessed evoked reflex recordings in the triceps surae muscles during rest and maximal voluntary contraction (MVC), rate of force development (RFD), and muscle mass in seven elderly (74 ± 6 years) males before and after 8 weeks of heavy resistance training, contrasted by seven young (24 ± 4 years) male controls. At baseline, m. soleus (SOL) V/M ratio (0.124 ± 0.082 vs. 0.465 ± 0.197, p < 0.05) and H/M ratio (0.379 ± 0.044 vs. 0.486 ± 0.101 p = 0.07) were attenuated in elderly compared to young. Also, SOL H-reflex latency (33.29 ± 2.41 vs. 30.29 ± 0.67 ms, p < 0.05) was longer in elderly. The reduced neural drive was, despite similar leg muscle mass (10.7 ± 1.2 vs. 11.5 ± 1.4 kg), mirrored by lower MVC (158 ± 48 vs. 240 ± 54 Nm, p < 0.05) and RFD (294 ± 126 vs. 533 ± 123 Nm s⁻¹, p < 0.05) in elderly. In response to training SOL V/M ratio (0.184 ± 0.092, p < 0.05) increased in the elderly, yet only to a level ∼40 % of the young. This was accompanied by increased MVC (190 ± 70 Nm, p < 0.05) and RFD (401 ± 147 Nm⋅s⁻¹, p < 0.05) to levels of ∼80 % and ∼75 % of the young. H/M ratio remained unchanged. These findings suggest that changes in supraspinal activation play a significant role in the age-related changes in muscle strength. Furthermore, this motor system impairment can to some extent be improved by heavy resistance training.     

Effect of resistance training with different frequencies and detraining on muscular strength and oxidative stress biomarkers in older women

The aim of this study was to compare the effect of resistance training (RT) performed with different frequencies followed by a detraining period on muscular strength and oxidative stress (OS) biomarkers in older women. Twenty-seven physically independent women (68.8 ± 4.8 years, 69.1 ± 14.3 kg, 156.0 ± 6.5 cm, and 28.3 ± 4.9 to kg.m⁻²) were randomly assigned to perform a RT program for 2 or 3 days per week (G2X = 13 vs. G3X = 14) for 12 weeks followed by 12 weeks of detraining period. One repetition maximum (1RM) tests were used as measures of muscular strength (three exercises, three attempts for each exercise, 3–5 min of rest between attempts, and 5 min of rest between exercises). Advanced oxidized protein products (AOPP) and total radical-trapping antioxidant parameter (TRAP) were used as oxidative stress indicators. Both groups increased muscular strength after 12 weeks of training (P < 0.05) in chest press (G2X = +11.9 % vs. G3X = +27.5 %, P < 0.05), knee extension (G2X = +18.4 % vs. G3X = +16.7 %, P > 0.05), and preacher curl (G2X = +37.6 % vs. G3X = +36.7 %, P > 0.05). On the other hand, 12 weeks of detraining were not sufficient to eliminate the major effects produced by RT on muscular strength, although a significant decrease (P < 0.05) has been observed for chest press (G3X = −9.1 % vs. G2X = −10.2 %, P > 0.05), knee extension (G2X = −14.9 % vs. G3X = −12.1 %, P > 0.05), and preacher curl (G2X = −20.5 % vs. G3X = −17.4 %, P > 0.05). Pre- to post-training, both groups showed significant (P < 0.05) increases in TRAP (G2X = +6.9 % vs. G3X = +15.1 %) with no statistical significant difference between the groups (P > 0.05), and the scores remained elevated compared to pre-training after 12 weeks of detraining. AOPP was not changed by RT or detraining (P > 0.05). The results suggest that a 12-week RT program with a frequency of 2 days per week may be sufficient to improve muscular strength and OS in older women and detraining for 12 weeks does not completely reverse the changes induced by RT.     

Value of acoustic cardiography in the clinical diagnosis of coronary heart disease

BackgroundTo investigate the clinical value of acoustic cardiography in the diagnosis of coronary artery disease (CAD) and post‐percutaneous coronary intervention (PCI) early asymptomatic left ventricular systolic dysfunction.MethodsInpatients in the department of cardiology were included in the research (n = 315); including 180 patients with angina pectoris and 135 patients with acute anterior wall myocardial infarction after emergency PCI did not present with signs and symptoms of heart failure. Color Doppler echocardiography, brain natriuretic peptide, acoustic cardiography examination were performed. The patients were divided into four groups: non‐CAD group (n = 60), CAD group (n = 120), MIREF group (EF% < 50%, n = 75), and MINEF group (EF% ≥ 50%, n = 60).ResultsAcoustic cardiography parameters EMATc, systolic dysfunction index, S3 strength and S4 strength in the MIREF group were higher than those in MINEF group (p < .05), and the MINEF group was higher than CAD group (p < .05). S3 strength (area under the curve [AUC] 0.67, 95% CI 0.585–0.755, p < .001) and S4 strength (AUC 0.617, 95% CI 0.536–0.698, p = .011) are useful in the diagnosis of CAD. S3 strength (AUC 0.942, 95% CI 0.807–0.978, p < .001) was superior to other indicators in the diagnosis of early left ventricular systolic dysfunction after myocardial infarction.ConclusionS4 combined with STT standard change can improve the diagnosis of CAD. Acoustic cardiography can be used as a non‐invasive, rapid, effective, and simple method for the diagnosis of asymptomatic left ventricular systolic dysfunction in the early stage after myocardial infarction.     

Disentangling the effects of circulating IGF-1, glucose,and cortisol on features of perceived age

Circulatory levels of insulin-like growth factor (IGF-1), glucose, and cortisol have been previously associated with facial aging. However, as these serum measures are related, it is unclear whether their associations with skin aging occur independently from each other. We aimed to investigate whether the associations between serum IGF-1, glucose, and cortisol levels and perceived age/wrinkle grade occur independently of each other and whether these are mediated via skin wrinkling or via other skin aging features. Perceived age and skin wrinkling grade were assessed in a random sample from the Leiden Longevity Study with non-fasted (N = 579) and fasted blood sampling (N = 219). In our study population, a higher non-fasted IGF-1 level was associated with a lower skin wrinkling grade (p value = 0.014) and tended to associate with a lower perceived age (p value = 0.067), which was mediated for approximately 100 % by skin wrinkling. A higher non-fasted glucose level was associated with a higher perceived age (p value = 0.017), which was mediated for 51 % by skin wrinkling grade (p value = 0.112). A higher fasted cortisol level tended to associate with a higher perceived age (p value = 0.116), which was mediated for 29 % by skin wrinkling. Results remained similar when the serum measures were statistically adjusted for each other. Thus, the previously reported serum measures associate independently from each other with skin aging. IGF-1 is predominantly associated with perceived age by skin wrinkling, whereas cortisol and glucose also by other skin aging features.     

Beneficial effects of lifelong caloric restriction on endothelial function are greater in conduit arteries compared to cerebral resistance arteries

Endothelial dysfunction occurs in conduit and cerebral resistance arteries with advancing age. Lifelong caloric restriction (CR) can prevent the onset of age-related dysfunction in many tissues, but its effects on cerebral resistance artery function, as compared with conduit artery function, have not been determined. We measured endothelium-dependent dilation (EDD) in the carotid artery and middle cerebral artery (MCA) from young (5–7 months), old ad libitum fed (AL, 29–32 months), and old lifelong CR (CR, 40 % CR, 29–32 months) B6D2F1 mice. Compared with young, EDD for old AL was 24 % lower in the carotid and 47 % lower in the MCA (p < 0.05). For old CR, EDD was not different from young in the carotid artery (p > 0.05), but was 25 % lower than young in the MCA (p < 0.05). EDD was not different between groups after NO synthase inhibition with N^ω-nitro-l-arginine methyl ester in the carotid artery or MCA. Superoxide production by the carotid artery and MCA was greater in old AL compared with young and old CR (p < 0.05). In the carotid, incubation with the superoxide scavenger TEMPOL improved EDD for old AL (p > 0.05), with no effect in young or old CR (p > 0.05). In the MCA, incubation with TEMPOL or the NADPH oxidase inhibitor apocynin augmented EDD in old AL (p < 0.05), but reduced EDD in young and old CR (p < 0.05). Thus, age-related endothelial dysfunction is prevented by lifelong CR completely in conduit arteries, but only partially in cerebral resistance arteries. These benefits of lifelong CR on EDD result from lower oxidative stress and greater NO bioavailability.     

The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures

BackgroundTransesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE).HypothesisEchocardiographic phenomena may determine the difficulty and safety of the procedure.MethodsData from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed.ResultsTEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead‐to‐lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%) and lead‐dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate analysis were: fibrous tissue binding the lead to atrial wall (OR = 1.738; p < 0.05), to right ventricular wall (OR = 2.167; p < 0.001), lead‐to‐lead binding sites (OR = 1.628; p < 0.01) and excess lead loops (OR = 1.488; p < 0.05). Lead‐to‐lead binding sites increased probability of major complications (OR = 3.034; p < 0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR = 0.296; p < 0.05), right atrial wall (OR = 323; p < 0.05) and right ventricular wall (OR = 0.297; p < 0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR = 0.307; p < 0.05).ConclusionsCareful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.     

Prognostic Impact of Serum Growth Differentiation Factor 15 Level in Acute Myeloid Leukemia Patients

Growth differentiation factor 15 (GDF15) plays an important role in cancer pathophysiology and prognosis. However, limited studies analyzed its level and prognostic value in acute myeloid leukemia (AML) patients. This study included 56 adult AML patients. Serum GDF15 level was measured at diagnosis in all patients by enzyme-linked immunosorbent assay. Remission and survival statuses were assessed at 90 days following treatment. GDF15 level was significantly higher in patients than in controls (P < 0.001). GDF15 level correlated positively with age (P < 0.001), hemoglobin level (P = 0.027), and platelet count (P = 0.024). High GDF15 above the median level was associated with inferior OS (P = 0.044) together with high platelet count (P = 0.006) and high bone marrow blast percent (P = 0.038). There was no statistically significant difference between patients with GDF15 above and below the median level regarding DFS (P = 0.881). On multivariate analysis for OS, GDF15 level was an independent risk factor (P = 0.047). In conclusion, serum GDF15 level is significantly elevated in AML patients and high GDF15 level is associated with inferior OS.     

Effectiveness of Lifestyle and Drug Intervention on Hypertensive Patients: a Randomized Community Intervention Trial in Rural China

BackgroundStrict medication guidance and lifestyle interventions to manage blood pressure (BP) in hypertensive patients are typically difficult to follow.ObjectiveTo evaluate the 1-year effectiveness of lifestyle and drug intervention in the management of rural hypertensive patients.DesignRandomized community intervention trial.ParticipantsThe control group comprised 967 patients who received standard antihypertensive drug intervention therapy from two communities, whereas the intervention group comprised 1945 patients who received antihypertensive drug and lifestyle intervention therapies from four communities in rural China.Main MeasuresData on lifestyle behaviors and BP measurements at baseline and 1-year follow-up were collected. A difference-in-difference logistic regression model was used to assess the effect of the intervention.Key ResultsBP control after the 1-year intervention was better than that at baseline in both groups. The within-group change in BP control of 59.3% in the intervention group was much higher than the 25.2% change in the control group (P < 0.001). Along with the duration of the follow-up period, systolic and diastolic BP decreased rapidly in the early stages and then gradually after 6 months in the intervention group (P < 0.001). In the intervention group, drug therapy adherence was increased by 39.5% (from 48.1% at 1 month to 87.6% at 1 year) (P < 0.001), more in women (45.6%) than in men (31.2%; P < 0.001). The net effect of the lifestyle intervention improved the rate of BP control by 56.1% (70.8% for men and 44.7% for women). For all physiological and biochemical factors, such as body mass index, waist circumference, lipid metabolism, and glucose control, improvements were more significant in the behavioral intervention group than those in the control group (all P < 0.001).ConclusionThe addition of lifestyle intervention by physicians or nurses helps control BP effectively and lowers BP better than usual care with antihypertensive drug therapy alone.Electronic supplementary materialThe online version of this article (10.1007/s11606-019-05601-7) contains supplementary material, which is available to authorized users.KEY WORDS: hypertension, lifestyle intervention, effectiveness, blood pressure control rate     

The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope

BackgroundThe contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive.HypothesisWe assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences.MethodsWe assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head‐up tilt test (HUTT).ResultsA total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m², p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures. Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05).ConclusionsPatients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.     

Correlation between goniometric measurements of range of motion and radiographic scores in osteoarthritis knee: An observational study among females

Osteoarthritis (OA) is a chronic degenerative joint disease. Different radiological changes are found according to grades. Range of motions (ROMs) of knee decreases with severity of OA. Women are more sufferer than men in OA knee. Objective was to correlate goniometric ROM with Kellgren-Lawrence (KL) radiographic score of female osteoarthritic knee. The study was a cross-sectional study conducted in Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, from February 2020 to March 2021. According to ACR (American College of Rheumatology) criteria, total 66 patients with primary OA knee were selected and examined in this study. Maximal flexion, extension, and rotation movements were measured by a universal goniometer. X-ray of standing both (A/P and lateral) view and skyline view of knee joint were taken and assessed with KL radiographic scores for medial, lateral, and patellofemoral compartments. Correlations between ROMs and KL scores were analyzed by Pearson correlation test. Among the 66 patients, mean age was 53.59 ± 7.19 years and mean body mass index was 26.62 ± 3.35. Majority (84.8%) of the patients were housewives. Mean maximum flexion was 126.71 ± 4.88°, maximum extension was –3.98 ± 1.74°, and internal and external rotations were 6.38 ± 1.29 and 8.48 ± 1.55°, respectively. More than half of patients had medial compartment KL score 3 or more while KL score 2 was found in 47% and 62.1% patients, respectively, in lateral and patellofemoral compartments. Statistically significant negative correlations were found between range of motion and radiographic scores. Strong correlation was present between maximal flexion and medial compartment score (r = –0.821, P < .001), whereas moderate correlation with other compartments. Extension values were moderately correlated with patellofemoral scores (r = –0.560, P < .001) and weakly correlated with rest of radiographic scores. Internal and external rotation were more related with medial compartment (r= –0.469, P < .001) and lateral compartment scores (r = –0.481, P < .001), respectively, than other compartment scores. There were significant negative correlations between goniometric measurements of knee ROM and radiographic scores in osteoarthritis knee in female patients.     

Are Hematologic Patients Trojan Horse for COVID-19?

Coronavirus disease 2019 (COVID-19) which is caused by severe acute respiratory distress syndrome virus (SARS-CoV-2) continues to affect people all around the world. This study aimed to compare the SARS-CoV-2 viral shedding time between patients diagnosed with hematologic diseases (HD) and a control group. A total of 110 patients were enrolled in this retrospective study; 55 patients with a diagnosis of HD and 55 sex and comorbidity matched controls without a diagnosis of HD, who caught COVID-19 at the same period. Thirty-eight patients were hospitalized in each group. Viral shedding time, COVID-19 severity, need for intensive care unit support, and mortality rates were compared between groups. Median viral shedding time was 24 days in hospitalized HD patients and 12 days in the hospitalized control group (p < 0.01) as 20 days in outpatient HD patients and 10 days in the outpatient control group (p = 0.02). Viral shedding time was longer in severe + critical COVID-19 cases in the whole cohort (median 22 days in severe + critical, and 12 days in mild + moderate) (p < 0.01). Severe + critical COVID-19 was more common in the HD group than the control group (47.2% versus 25.4%, respectively) (p = 0.017). Twenty-five patients were dead in the whole cohort. One patient was in the control group and 24 patients were in the HD group, therefore the mortality rate for the HD group was 43.6%. Because of statistically significant longer viral shedding time, longer-term isolation may be necessary for hematologic patients diagnosed with COVID-19.